Addressing the Problem of Hospital Readmissions

Addressing the Problem of Hospital Readmissions

Arya SedehiHS 8803

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StatisticsStatistics

• Hospitals account for 31% of total health expenditures

• Medicare Beneficiaries– 19.6% of patients are readmitted

within 30 days– Accounts for $15 billion in spending

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Types of ReadmissionsTypes of Readmissions

HospitalReadmission

Avoidable Unavoidable

Clinical Characteristics

Demographic OperationalFactors

Planned Unplanned

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Types of Readmissions (1)Types of Readmissions (1)

• Avoidable– Result of medical error, lack of social support or lack of

understanding of discharge instructions– Shows poor quality of care

• Unavoidable– Necessary based on diagnosis of patient

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Avoidable ReadmissionsAvoidable Readmissions

• Demographics

• Clinical Characteristics

• Operational Factors

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Avoidable Readmissions (1)Avoidable Readmissions (1)

Demographics

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Avoidable Readmissions (2)Avoidable Readmissions (2)

Clinical Factors• Medications• Comorbidities

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Avoidable Readmissions (3)Avoidable Readmissions (3)

Operational Factors

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Hong Kong Case Study Hong Kong Case Study

• Causes of Readmissions

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Current Proposed SolutionsCurrent Proposed Solutions

• During Hospitalization

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Current Proposed Solutions (1)Current Proposed Solutions (1)

• At Discharge

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Current Proposed Solutions (2)Current Proposed Solutions (2)

• Post-Discharge

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Current Proposed Solutions (3)Current Proposed Solutions (3)

• Project BOOST

• Preliminary Results– Improved St. Mary’s readmission– Improved patient satisfaction

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Priority-Based StrategiesPriority-Based Strategies

• Low Effort Strategies– Implemented with hospital’s existing resources

• Medium Effort Strategies– May require hospitals to acquire additional resources

• High Effort Strategies– May necessitate installation of complex and costly

systems

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Priority-Based Strategies (1)Priority-Based Strategies (1)

• Case Study– Multisite randomized controlled study– Coordination of care across multi-disciplinary team – Use of EMRs to support care coordination– Use of Transitional Care Nurse to coordinate care – High Effort– Annual average savings at $4,845 per patient

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My ConsiderationsMy Considerations

• Focus on pre-discharge, at-discharge, and post-discharge interactions with patient and caregiver

• Make sure patients adhere to Medicine Reconciliation

• Utilize IT to track readmissions over time and create an index

• Change hospital reimbursement depending on readmission rates

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My Considerations (1)My Considerations (1)

• RFID Technology

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My Considerations (2)My Considerations (2)

• Patient and Asset Tracking

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My Considerations (3)My Considerations (3)

• Benefits of RFID tracking in hospitals– Improves equipment utilization & reduces losses– Improves staff productivity and efficiency– Can reduce medical errors and improve patient care

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Questions?Questions?

References• Allaudeen, Nazima. 2011. “Redefining readmissions risk factors for general medicine patients,” Journal

of Hospital Medicine. 6, 54-60. • Benbassat, J. and M. Taragin. 2000. “Hospital readmissions as a measure of quality of health care,”

Archives of Internal Medicine. 160(8), 1074-1081. • California Health Advocates. 2010. “Creative interventions reduce hospital readmissions for Medicare

beneficiaries.” http://www.cahealthadvocates.org/news/basics/2010/creative.html• Catlin, A. et al. 2008. “National health spending in 2006: A rear of change for prescription drugs,” Health

Affairs, 2714-2729.• Halfon, Patricia. 2002. “Measuring potentially avoidable hospital readmissions,” Journal of Clinical

Epidermiology, 55, 573-587. • Health Research & Educational Trust. 2010. “Health care leader action guide to reduce avoidable

readmissions,”• Minott, Jenny. “Reducing hospital readmissions.” Academy Health. http://www.academyhealth.org• Personal Communication with Stephen F. Jencks, M.D., M.P.H., Mark V. Williams, M.D., and Eric A.

Coleman, M.D., M.P.H., April 2008.• SMM Project BOOST. “Reducing unnecessary readmissions and so much more.” Society of Hospital

Medicine.• Westert, Gert. 2002. “An international study of hospital readmissions and related utilization in Europe

and the USA.” Health Policy, 61, 269-278.